Subacute Post-Traumatic Ascending Myelopathy (SPAM) in a Spinal Cord Injured Patient - a Rare Presentation: A Case Report

Subacute Posttraumatic Ascending Myelopathy After Thoracolumbar Spinal Cord Injury

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Subacute posttraumatic ascending myelopathy (SPAM) is defined as neurological deterioration ascending four or more levels above the initial injury level and occurring within the initial days to weeks after spinal cord injury (SCI).

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SPAM is a rare complication of spinal cord injury with an incidence of 0.42% to 1% affecting young to middle-aged male patients.

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Several hypotheses have been put forth to explain SPAM, but the exact pathomechanism remains elusive.

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Treatment guidelines for this rare entity are uncertain and still to be developed.

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The current prognosis of SPAM is poor, with a mortality rate of 10.34%.

Posttraumatic ascending myelopathy after spinal cord injury in a young man: A case report

A 29‐year‐old man developed subacute posttraumatic ascending myelopathy 5 days after a spinal cord injury. He developed a fever and a blood culture showed an Alkaligenes spp. infection. Despite antibiotic and high‐dose corticosteroid therapy, same neurological deficits persisted, and a follow‐up MRI showed atrophy and swelling in the cervical cord.

Subacute Posttraumatic Ascending Myelopathy: A Rare Complication After Thoracolumbar Spinal Cord Injury: A Case Report

CASE

A 45-year-old man presented with posttraumatic fracture-dislocation of T11/12 with neurological level T8 AIS A. Sensory level progressed to T4 in the next day morning. He underwent T10, T11, T12, and L1 percutaneous pedicle screw-rod fixation. Postoperatively, there was rapid worsening of his neurology and within 48 hours, he became tetraplegic with neurological level C2 with respiratory paralysis requiring mechanical ventilation. He died on the 14th postoperative day. Clinicoradiological findings were consistent with subacute posttraumatic ascending myelopathy (SPAM).

CONCLUSION

Surgeons must be vigilant in days and weeks after spinal cord injury for early recognition and management of SPAM. Treatment guidelines are uncertain and yet to be developed.